Guardianship application

Guardianship Application

In order to adopt, you must satisfy the following requirements:

You must be at least 21 years of age with proper proof of age. Current identification must show your correct address and phone number.
You must provide a landlord's phone number or a copy of your lease, if you rent.

Please fill out the following form and click "send information" button at the bottom of the form .

Name 1: *
( firstname lastname )

Name 2:
( firstname lastname )

Address:*

City:*

State:*

Zip Code:*

Country:*

Work Phone:
(e.g. xxx-xxx-xxxx)

Home Phone:*
(e.g. xxx-xxx-xxxx)

Mobile/Cellular/Pager :
(e.g. xxx-xxx-xxxx)

E-Mail Address:*

Employer:

Length of time at the present address:*

When were you hoping to adopt :*

Immediately
In the next few days
In the next few weeks
In the next few months

Type of companion animal you are looking for:

Puppy        Kitten

Adult Dog Adult Cat

Rabbit

Other (please specify)

Names of the animals

Characteristics most important to you:

Good with all dogs yes no Good with children yes no

Energetic yes no Good with some dogs yes no

Housebroken yes no Good with cats yes no

Mellow yes no Declawed (cats) yes no

Other (please specify) size of animal small medium large

Number of people in the household:

Adults   Children

specify ages of children (separate by commas)

Why are you interested in adopting a pet? Check all that apply:

Gift   To breed

Companion for another pet

Mouser For protection

Companion for me For a child

Replace previous pet

For how long have you been considering adopting a companion animal? *

Is this your first companion animal? yes no

Do you currently have other companion animals? yes no

Please list all your companion animals, past and present:

Type of animal (dog,cat,rabbit.....)

Age*

Male/Female

Breed or Mix of Breeds

weight (lbs)

Neutered/Spayed

Vaccinations current

Surgical alterations

Where resides currently

* If deceased, please select approximate age at death.

Have you ever applied to this rescue before? yes no

Have you applied to any other rescue organizations before? yes no

if yes, please list them as it may expedite the processing of your application:

Name of shelter

Date applied

How do you plan to introduce your companion animal to other animals and/or people in the household?*

Are you prepared to spend several weeks or, perhaps months, waiting for your new companion animal
to adjust to their new environment? And for you to adjust to this animal?*

Who is or will be your Veterinarian? Please list name, address, and phone number:*

How much money do you anticipate on spending on your new companion animal's annual doctor visits?*

What yearly vaccines will your companion animal receive?*

What is the longest period of time you would leave your companion animal unattended outside?*

Do you have any of the following:

Completely fenced in backyard? (if so how high)

An Outside run? yes no

Dog house? yes no

Training crate? yes no

Basement yes no

Garage ? yes no

DoggieDoor ? yes no

Balcony ? yes no

Where will your pet be kept during the day?*

Where will your pet be kept at night?*

What is the most amount of hours the animal will be left alone?*

What brand of food will you feed your pet?*

What are your beliefs regarding spaying/neutering?*

What are your beliefs regarding obedience training?*

Who will be primarily responsible for feeding/caring for your new pet?*

What do you believe is the average life expectancy of a dog/cat?*

Do you rent or own?    rent own
If you rent, please provide your Landlord's name & phone number (or a copy of your lease)

How did you hear about our shelter?*

Have you ever turned an animal into a shelter?*
yes no

If yes, what were the circumstances?

Which, if any, of the following behaviors/situations present a problem for you? How would you handle the following:

Jumping on furniture/counters/tables?*

Destroying/scratching the furniture? *

Chewing?*

Barking?* (please mention -NA- for animals other than dogs)

Urinates/defecates where it is not acceptable?*

Keeps you awake at night?*

Sheds excessive hair?*

Ruins your favorite article of clothing?*

Biting/play biting?*

Allergies that a current household member may develop to your new companion animal? *

Medical expenses (emergencies and diagnosis of a medical condition)?*

Moving?*

When home alone, the dog will be (check all that apply)

in a crate wire cage dog pen inside

In a kennel that is: outdoor indoor both

Tied up outside with a: cable run chain

Dog will be kept loose: indoor outdoor

Other, please specify

How will you exercise the dog (check all that apply)

Leash walks every day

Will have cable or dog run in the yard

Will be free to run in a fenced yard

Will have supervised off leash exercise in unfenced area

Will be free to roam around

Will bring to dog park (Public area where dogs can run and play together off-leash)

Other, please specify

Please provide the names and phone numbers of two references not related to you: *

Name Phone Number

I certify that the information I have provided is accurate and honest.*

print your name( firstname lastname )

date

print your name( firstname lastname )

date